Application to Speak at AS & Depression Conference

General Information

Please complete this form if you would like to be considered to be a speaker at the AANE/Aspire/FFDA spring conference on depression and Asperger Syndrome.

The form contains a few basic questions (name, address, etc.) and then provides you with a space to enter your personal story or account. The length of each talk will be 5-7 minutes.

1. Name
2. Street Address
3. City
4. Country
5. Email Address
6. Telephone Number
7. Is the above number your:
8. Website or Personal Blog
9. Will you be available to speak at the conference at Pine Manor College in Brookline, MA on Friday, March 14, 2014?
10. What is your relationship to the person about whom the account is written?
11. If you work with the person with AS in a professional capacity, what is your profession?
Please be as specific as possible.
12. How old is the person with AS?
13. Please use this space to document your experience with depression.

If you are writing about yourself, consider addressing the topics below:

-what symptoms you experienced
-how your functioning was effected
-how you decided to seek treatment, which treatments you tried
-what you feel helped and did not help
-how you think the Aspergers affected your depression and treatment
-impact on your family and friends
-response of clinicians

Clinicians and family members should consider those same topics when writing about their client or family member's experience of depression.
14. Describe any experience you have had with public speaking. (This is not a prerequisite for being chosen as a speaker.)
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